Aortic dissection

Tear in he sorta leading to dissection

3x common in meals that females ; age 50-70

Pathology

Sudden, loc altered, sob, neuro s/s, sweating and a weak pulse ( one arm)

Require lifelong bp meds

Poor controlled hypertension, trauma? And cocaine use

Cause: rupture in the intimate level

Rupiuture through the layers causing blood to renewer the sac which result in chronic dissection or occlusion of the aorta branch

Arteries shear and occlude ; dissection occur in aortic arch

Progress towards the heart obstruction the arteries, producing effusion of blood into the pericardium sac

S/s:

Look pale, sweaty, tachycardia, elevated BP or differ from one arm to the next

Sudden, severe and persistent pain described as tearing or ripping

Located in the anterior check it back and extend to the should, epigadtruc area or abdomen

Mistake for MI

Cardiac, neuro, gastric symptoms

PreOp: semifowlers, quiet environments, anxiety and pain meds , bp meds, ecg and internal monitor check peripheral pulses and vitals

Post op

Pain return of process contact HCP

I

Raynauds Phenomenal

-Arterial vasoconstriction coldness, pale, pallor finger tips or toes, nipples, Hyperhidriosis- excessive sweating

-More common in females

-Onset at age of 30 yr old

Worsen or progressive

-Primary and idiopathic ( occur in absent of disease)

-Secondary related to disease ( connective tissue disorder)

  • hips, RA, scleroderma, trauma. Obstructive arterial lesions

Mild- no treatment

Vasospams and fixed blood vessels obstructions that lead to ischemia, ulceration, and gangrene

S/s:

  • pallor by sudden vasoconstriction

  • Skin cyanotic and pooling of deoxygenated blood during vasospasm - cause hyperemia

  • Rumor is produced when oxygenation blood return to digits after vasospasm stop

  • Color change: white, blue and red, numbness, tingling, and burning pain occurs as color change.

  • Bilateral and symmetrical


Medical Management

Avoid cold and nicotine cause vasoconstriction ; trauma

Decongestants and otc

Calcium channel blockers- relieve symptoms

Nurse:

Avoid stimulation and stressful and unsafe situations Minimized exposure to cold

Wear layers of clothes outdoor, hats, gloves or mittens should be work at all times when outside

Fabrics designed for cold environments

Wear gloves when in the freezer and warm up vehicles to avoid touch cold steering wheel or door handle

Summer.- sweater should be available wheh entrr we got air- conditioning room

Avoid finger injury

Inform about Orthostatic hypotension

VENOUS THROMBOEMBOLISM AND PE

Silent and asymptomatic

Covid 19 victims at Rosie for vet and pulmonary thrombi

See elevated D- Dimer levels ( show evident of clots) with PT state

Virchow triad:

Endothelial damage? Venous status, and altered coagulation

Demands to the lining of the vessel create a state for clots

Venous stasis- reduced blood flow, vein dilated and skeletal muscle contractions is reduced

Altered anticoagulant- medication coagulations are abruptly stopped